Medical health bodies push for graduate exit exam

Frustrated professional bodies in Uganda's health sector have mooted the idea of introducing exit examinations for graduates seeking to enter the health professions in a bid to improve the quality of students being churned out by universities.

“You can’t imagine the averageness of some of the graduate doctors we receive from institutions of higher learning in this country,” said Dr Katumba Ssentongo Gubala, registrar of the Uganda Medical and Dental Practitioners Council (UMDPC), in an interview at his office in Mulago, Kampala. “These are young men and women fresh from medical school. But they lack even the basics [regarding the profession].”

The registrar said the council is working on a framework to introduce exit exams for every Bachelor of Medicine and Surgery graduate who intends to practise in Uganda.

“We [the UMDPC] shall set a test. It will be sort of a quality assurance exam. Only graduates who pass it will be allowed in our wards,” said the registrar.

Mediocrity

“We cannot sit and keep watching mediocre graduates enter our profession,” says Gubala. “We are doctors. We save lives. We have to be good, excellent.”

The UMDPC is not the only health professions body concerned with the quality of graduates.

Samuel Opio, secretary of the Pharmaceutical Society of Uganda, said the society is already subjecting pharmacy graduates to pre-internship tests before they are absorbed into the profession, first as interns, and then as licensed pharmacists.

“We want to eliminate half-baked graduates and at the same time set a standard for pharmaceutical practice in the country,” said Opio, in a telephone interview.

The body responsible for midwives, the Uganda Nurses and Midwives Council (UNMC), has also not been left behind.

Registrar Rebecca Nassuna told University World News the nurses and midwives’ council had completed a draft strategy for the setting and scoring of exit examinations in May this year for graduates who intended to join the profession. What remains for the strategy to be implemented is endorsement from the Ministry of Health.

The moves by the professional bodies also have the backing of the local health ministry.

Guidelines

Dr Diana Atwine, permanent secretary of the Health Ministry, said in a telephone interview that quality was paramount and the ministry was looking forward to formulating guidelines which will govern exit exams for graduates who want to enter the medical profession.

The quality of training at a number of universities and higher institutions of learning in this East African country is wanting, with many institutions prioritising numbers and profits rather than quality.

According to a 2016 assessment by the East African Medical and Dental Practitioners Councils of medical schools in the East African Community (EAC), most schools lacked basic infrastructure for training of medical officers. A number of institutions were dogged by inadequate staffing, funds and training materials.

Even the curricula and course designs at some institutions were found lacking, omitting ‘key ingredients’ which make a medical officer.

There was an incident last year when the nurses’ council refused to register more than 1,000 nursing graduates over ‘inadequate’ academic papers. The story was widely reported in local media.

The nursing students affected were mainly from private universities. The council said the students were admitted to a Bachelor of Science in Nursing at the institutions of higher learning but hadn’t obtained two principal passes at their ‘A’ levels. The UNMC demands that students obtain at least two principal passes at ‘A’ level to enrol for an undergraduate programme related to the profession.

Quantity over quality

Professor Anthony Mbonye, former director general of health services in Uganda, said in an interview at Makerere University that institutions of higher learning “churn out” bigger and bigger numbers every year. But the expert is not sure about the quality of training the current medical graduates get.

“Some universities pass more than 500 medical graduates a year. That is a problem,” he said.

There are 12 public universities in Uganda and approximately 30 private institutions of higher learning in the East African country.

If the move by the professional bodies is approved, every medical graduate will sit an examination set by the Uganda Medical and Dental Practitioners Council. Nursing graduates will sit a similar examination set by the Uganda Nurses and Midwives Council. Pharmacy graduates will continue to sit exit exams set by the Pharmaceutical Society of Uganda.

Graduates who fail the tests will have an opportunity to repeat the test three times or they will have to re-study the entire undergraduate programme and sit the exit tests afresh if they want to practise in Uganda or the East Africa region.

Opposition

The umbrella body for medical students in the country, the Uganda Medical Interns’ Association, and the Uganda Medical Association are opposed to the move.

Robert Lubega, the president of the Uganda Medical Interns’ Association, said the focus should be on improving universities and empowering institutions of higher learning so they are better equipped to teach.

“You cannot start saying graduates have to sit exit exams. It is ridiculous. These universities have been certified and given charters to award programmes,” he said.

The same argument is made by Dr Ekwaro Obuku, president of the Uganda Medical Association, who told University World News the state should look at equipping its universities with the necessary infrastructure to improve modes of training.

Professor John Opuda-Asibo, executive director at the Uganda National Council for Higher Education (UNCHE), acknowledged that higher quality is needed but said training – whether it is quality or not – is more dependent on the attitude of specific learners than the university.

He said students have to work hard after they meet minimum requirements and are admitted to universities.

“Some students are admitted with AAAs and graduate with pass degrees. This is a problem,” said the UNCHE boss.

Standardisation

However, Opio of the Pharmaceutical Society of Uganda argued that pre-internship tests will help to standardise the quality of graduates and give a yardstick for acceptable levels of skill needed to practise in the EAC country.

“We have graduates from local and foreign universities. The test serves as quality assurance,” he said.

“No one who has studied pharmacy should fear the exam,” he went on to say, in a telephone interview. The test also gives feedback to institutions to improve their training.

In efforts to improve quality, especially of medical officers, government is also discussing the possibility of allowing graduates to work at health facilities for two years under close supervision from senior mentors.

The permanent secretary said in an interview the young doctors would be paid salaries like other health workers and given other incentives like accommodation as they get the expertise in the profession.

After the two years of ‘bonding’, the medical workers would have first priority for government scholarships to enter postgraduate programmes and specialise. Through bonding, government hopes to create skilled health workmanship.